Bacteriology of Hand infections

- See Human Bite

- Bacteria Sensitive to Augmentin / Unasyn
    - staph aureus
           - along w/ streptococcus is the most common inciting organism in hand infections;
    - streptococcal Gr A beta hemolytic
           - shows cellulitis, lymphangitis, lymphadenopathy, fever, and a systemic toxic reaction;
           - in general, none of the Gr A organisms are resistant to penicillin or tetracycline, however, non Gr A organisms
                   may be resistant;
           - symbiotic infections:
    - erysipelothrix rhusiopathiae - Streptothrix -
    - pateurella multocida:
    - bacillus anthracis:
    - eikenella corrodens:
    - neisseria gonorrhoeae:
           - may produce a tenosyovitis or arthritis difficult to differentiate from the usual pyogenic infection;
           - smear for diplococcus and culture on special media may aid in dx;
           - penicillin is used for treatment;
    - treponema pallidum:
           - may cause a primary lesion that could be mistaken for a paronychia;
           - tertiary lesions may involve tendon sheaths, bone, and joint;
    - actinomyces bovis
           - enters thru an abrasion on the skin, assoc. w/ cattle, swine ect;
           - granuloma occurs that resembles TB, & sinus formation results;
           - infection may be resent to treatment;
           - treatment includes penicillin and potassium iodide;

- Misc Infections:
    - myobacterium tuberculosis:
           - may cause finger joint involvement as well as tenosynovitis or sking or bone lesions;
           - tuberculosis dactylitis is usually seen in children;
           - references: Spina Ventosa NEJM Case Records.
    - myobacterium marinum:
    - vibrio vulnificus:
    - blastomyces dermatitidis:
           - may occur in the fingers as a pustule that becomes larger and spreads peripherally;
           - center heals, leaving a central scar with a spreading perimeter;
           - if osseus lesions occur in the digits, they may be secondary to to pulmonary disease;
           - treatment is with dihydrosystilbamidine or amphotericin B;
    - aeromonas hydrophila: freshwater bacteria;
    - sporotrichum schenckii:
           - is a fungus that may be introduced into the extremity thru abrasions caused by thorns;
           - common in those who handle soil and plants;
           - delayed dx is common
                   - 4 months for lymphocutaneous form
                   - 25 months for deep infections (requires Ampho B or Ketoconazole)
           - abscess develops and spreads to the regional lymphatics, resulting in multiple granulomas, which occur along the
                   course of the lymphatics, and ulcerate as the area is ruptured;
           - potassium iodide is the drug of choice;
    - coccidioides immitis
           - may involve the hand and the ulnar and radial bursae;
           - it is an uncommon infection;

- Viral Infections:
    - lymphogranuloma vereeum: transmitted by a bite or scratch;
    - herpes
    - Images in Clinical Medicine. Contagious Ecthyma
    - Images in Clinical Medicine. Herpetic Whitlow

Abscesses secondary to parental abuse of drugs. A study of demographic and bacteriologic characteristics.

Bacterial colonization of mutilating hand injuries and its treatment.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, December 1, 2016 10:16 am